Twins joined at head are separated
Egyptian boys in induced comas at Texas hospital
(CNN) -- Doctors in Dallas, Texas, separated 2-year-old conjoined Egyptian twins during a grueling 34-hour operation that ended Sunday.
"We've got to just take this a step at a time, and this has been a giant step," said neurosurgeon Kenneth Shapiro of Children's Medical Center.
Ahmed and Mohamed Ibrahim -- who had been joined at the top of the head -- were separated at 12:17 p.m. EDT, after neurosurgeons finished dividing the boys' venous systems and brains.
"The boys right now are medically stable. We're still completing the skin closure on them," Shapiro told reporters Sunday evening.
"Our plans are basically to keep them in a medically induced coma for several days. Their vital signs are stable, and we don't see any sign that there have been any medical problems."
The boys still face a number of hurdles, including the possibility that clots will form, leading to stroke, said Dr. Bradley Weprin, who is in charge of the follow-up care.
The lengthy period during which their scalps and skulls were open "give us significant concern," Weprin said.
Swelling of the brain and the possible leakage of spinal fluid are also risks, he said.
"Most critical is the behavior of the wounds and how well they're going to heal."
Neurosurgeon John Vlasec said the most difficult part of the operation came when he tried to separate the left hemisphere of Mohamed's brain from its interface with Ahmed's right hemisphere.
"It was very, very stuck together," he said. "We knew that the brains would be touching each other. But we thought, in most of the cases, they would peel apart relatively easily. But at this location, they did not."
Neurosurgeon Dale Swift said it was "too early to tell" whether the twins suffered brain damage.
"We're going to be very concerned for them over the next few weeks," he said.
The surgery in Texas comes shortly after four-month-old twins, a boy and a girl, from Greece were successfully separated at a Rome hospital.
The twins, who were joined at the temple, were doing well after their surgery on Saturday, one hospital official said. (Greek twins separated)
That surgery was less complicated than the one carried out in Texas, since the infants didn't share any organs, news reports said.
To separate the Egyptian twins, doctors spent more than a year preparing.
Before the surgery, doctors put tissue expanders in each thigh of both boys to create extra skin they could use to cover the wounds created during the separation.
Three of the pieces were used to cover Mohamed's brain, and one was needed to cover Ahmed's brain, said Dr. Kenneth Salyer, a plastic surgeon.
No attempt was made to replace the boys' crania, though that could be done later, he said.
He credited "very careful planning" for the success so far.
The operation team consisted of more than 60 people. Shapiro said members tried to take catnaps during the ordeal, "but I think we have all been a little too involved to really sleep."
Dr. Abdelai Nasser described the parents' reaction when told their sons had been separated. The father "hugged me and he fainted. We had to care for him. He told me that he never dreamt of such a moment."
And the mother "was crying, like everybody else," he said. "She was there thanking everybody around."
The boys, who arrived at the hospital Thursday morning for two days of pre-operative preparation, were born in a town about 500 miles south of Cairo.
The World Craniofacial Foundation helped organize the endeavor and paid their way to Dallas.
The foundation has raised $125,000 for the separation surgery, which could cost $2 million, according to its Web site. The hospital and the medical team are donating their services, the foundation said.
The twins' deformity, called craniopagus twinning, occurs in 1 in 10 million live births, according to the foundation. About 2 percent of conjoined twins are connected head-to-head.